"The $93,00(0) is what a physician pays. But $150,000 is what the insurance has to pay for all the labs, infusion costs and Dr fees."

Oh really? I'm moving to your state, country, or planet as it seems.

And honestly, you should know your "biobetter":"Provenge is not a competing drug since it is doesn't affect androgens. The 2 drugs could even be synergistic together. Zytiga does compete with MDV3100. Imo Zytiga has shown a fairly benign side effect profile so far. However Zytiga does require 5mg bid dosing of prednisone which could cause problems if taken long term."

Zytiga if requiring prednisone, is a contraindication to Provenge. Provenge patients can not be on prednisone, so Zytiga can not be given simultaneously, as it is immunosuppressive and would retard the immune reponse stimulated by Provenge.

Totally doesn't apply to Provenge because it's not just a pill that is being marketed to doctors, that they can write and have the local pharmacy dispense; maybe they have to write a letter to the insurance to get the medication covered. The Provenge process is much more complex.

FDA approved for asymptomatic or minimially symptomatic. If it is preventing seeding of tumor to other locations (without necessarily shrinking the larger tumors) then the disease's ability to further spread is limited. This could lead to overall survival if the earlier tumors, even if metastatic, are not in dangerous parts of the body like the lymphatics, and soft tissue like the liver and brain.

Note also, the IMPACT exclusion criteria included those with soft tissue metastasis. Local soft tissue invasion to soft tissue like the bladder, was not exclusionary.

I think the number of reps is certainly reducible. As you know I work in a urology practice, I have seen that there was a lot of uncoordination between the reps, the Dendreon "On-Call" patient tracking system, and the organization to which paperwork is submitted for "co-pay assistance"- an organization called "Good Days" which helps to get unreimbursed amounts covered.

I see too little mentioned about the cost to the patient, in addition to the financial risk the practice undertakes. A 20% copayment for instance, despite his Medicare Supplemental, yielded a $6,700 co-insurance quote from Dendreon. My patient is likely going to cancel the treatment unless the copayment assistance comes through.

Additionally, Dendreon can cut paperwork and costs by putting an intelligible database on their website. The paperwork could be submitted electronically, and responses from Dendreon about patient clinical eligibility, copay assistance, transportation assistance, etc. can be housed there- instead of countless phonecalls from the rep, and to the Dendreon "On-Call" system.

This is literally what is limiting the offices from writing higher volumes in smaller practices with a high volume of patients waiting. In urology, this is ever so important due to the lack of urologists in rural areas (with high patient populations) where urologists don't like to work because the reimbursements for all urologic codes are LESS due to Medicare's "geographic multipliers"

All in all, DNDN is a hold, wait, and see if these business practices become easier. I still see them as the biggest barrier.

Had DNDN announced they would be opening their own infusion centers, and doing their own billing, then things would have changed radically as those business variables were borne.

As DNDN wishes to push into the realm of other cancers, I think they will be OK with all of these growing pains.

Dendreon's Provenge: What Are Patients And Doctors Saying? [View article]

It's also interesting and important to remember, if there is any trend that Provenge should take, as far as utility, it would be to utilize it at early stages in the disease, perhaps as soon as PSA is rising while on antiandrogens, so as not to let the prosate cancer set up in the bones (i.e. before a positive bone scan) this allowing the immune cells (T cells activated by the dendritic cells) less volume of disease to battle, and the patient would generally be younger with a better immune system.

Additionally, PSA as a marker of disease- we have to remember that PSA is released, in the majority, from ductal epithelia in the prostate. If the gland has been removed, then the PSA drops.

Those who choose not to have a radical prostatectomy may choose to go on antiandrogens earlier, which of course leaves more cells to target (the prostate). If Provenge is used in those men, the PSA might actually drop significantly.

Dendreon needs to study post-prostatectomy antiandrogen failures, and antiandrogen monotherapy failure patients, independantly, see if there is a statistical difference in the changes in PSA.

They have studied Provenge ONLY in the most challenging light- when the disease has progressed beyond therapy, the cells have "mutated" over to an aggressive androgen-independant state (or Castrate Resistant Prostate Cancer).

They also need to look, on the cellular or histological level, at the prostates of men who have received Provenge, and see if there is an effect on the prostate cells (via prostate biopsy- as it's not so likely the man would want his prostate out late)

From these urologic standpoints, I do see significant promise for further utilization of Provenge earlier in the disease state.

Dendreon's Provenge: What Are Patients And Doctors Saying? [View article]

If they restructure, and have their own infusion centers and take their own financial risks, it's a BUY BUY BUY

Anything else keeps them exposed to the same forces- doctors not wanting to take the financial risk, taking forever to get paperwork coordinated, etc.

If they tell us Gold steps down, and some aggressive marketing guru is going to take his place, and, they outline some online system that keeps patient data secure and organized (therefore making it easier to "sign them up") then BUY BUY BUY

If they just re-engineer their earnings projections- HOLD

There will be no takeover announcement, Dendreon is in this to stay independant, and continue their pipeline into other cancers.

If they reduce the price of the treatment, or combine it with a technology that makes delivery possibly in one infusion, reducing costs- BUY BUY BUY

If they announce significant additional barriers to sales, and the stock again tanks in cost, BUY BUY BUY!!! as that is yet another barrier which can be overcome.

You've had many office visits, an expensive robotic radical prostatectomy, a 12 core biopsy instead of the more common 10 core biopsy, multiple PSAs and testosterone levels, multiple radiation treatments because your margins were likely positive and you had a local recurrence of disease (despite your doctors telling you the more expensive robot would spare you of incontinence and impotence), you've had multiple anti-androgen shots. Yet you are on here saying that the $93k Provenge treatment is too expensive and is going no where.

Think about how much you've been through, and where your case is likely going. I hope you (and other patients) decide to put some faith in a new treatment with short duration flu-like side effects, after considering all the above treatments you've had and all the complications and associated illnesses and recovery times.

Come on, Zino, even I am so Pro-Provenge. Their side of the debate is usually valid and needs to be considered. These are all treatments with similar survival benefits, and the patient should be the one who decides with good guidance from their physicians.

You now embellished on the amputation over using "new antibiotics" that came out early in the last century.

Maybe you can site an article for me, zino, describing this dillemma you're fabricating- did it actually happen in medicine or were amputations usually (as they are today) covered with systemic antibiotics? Were there very smart doctors who HAD to amputate i.e. Army and Naval Corpsmen, perhaps at times rationing antibiotics?

Oh, believe me, I have a grasp on simple concepts, especially in baseless posts.

Your analogy does not stand, because it was edited with your retrospect-o-scope. Nor does it stand because the gravity of a physician's decision to utilize Provenge is so much larger than your simple example.